Screening for Risky Behaviors

By Dr. Alexis Hugelmeyer

We are losing our teenagers. We are losing them to drugs and alcohol, cigarette smoking, sexually transmitted diseases, motor vehicle accidents, suicide, homicide, depression, anxiety, eating disorders, unplanned pregnancy, gun violence, gang violence, bullying, peer pressure.

Adolescence is a difficult time for teens and parents alike. Our children are often dealing with very adult issues without your knowledge or input. The antagonism inherent in the parent-teen relationship often makes open communication difficult. Hopefully, your child has an adult, if not one of his or her parents, to confide in – perhaps a coach or teacher.

The yearly physical exam by your child’s pediatrician or family doctor is a unique opportunity for a trusted adult to capture the teen’s attention and screen for high risk behaviors. It is imperative that a physician build rapport with pediatric patients in their early childhood years so that by the time they are teens, they will trust the relationship as unbiased and non-judgmental.

My goal is that my teenage patients will see me not only as a doctor, but an advocate, a counselor, someone they can turn to with questions. My teenage patients must know that for the most part our discussions will remain confidential barring the idea of hurting themselves or others of course. This once-yearly encounter may be the only time anyone is asking about these behaviors. Most teens who display risky behaviors are afraid and desperately want someone to notice. Your child may be waiting for someone they trust to ask the tough questions. Make sure that you kid’s doctor is asking you to leave the room, so they can take the most honest appraisal. If they don’t ask you to leave, make sure you offer. Don’t be concerned about what your child might tell the doctor, be relieved that someone is asking the right questions. If the doc isn’t already, request that they spend time with anticipatory guidance.

Here is a list of questions I ask every adolescent starting around age 10. Of course, the questions depend on the child’s age and his or her risk factors…

• Do you wear sunscreen?
• Do you use a bike helmet?
• Do you always wear your seatbelt?
• Do you use drugs, alcohol or smoke cigarettes?
• Do you ever drive under the influence of substances?
• Do your friends ever pressure you to do things you don’t want to do?
• Have you tried any other substances such as huffing or bath salts?
• Are you or have you ever been abused – emotionally or physically? At school, at home or elsewhere?
• Do you ever harm yourself? Have you ever thought about hurting yourself or others?
• Are you sexually active? With men, women or both? Do you use protection every time? Do you use effective birth control every time?
• Are you comfortable with your sexuality? 
• Is there a gun in your home or in your friends’ homes?
• Are you involved in gang activity?
• Do you suffer from depression or anxiety?
• How do you feel about your body image?
• Do you binge and purge or go long periods without eating?
• Is there an adult that you trust and confide in?
• How are your grades?
• Are you being bullied at school?

Don’t lose your teenager to high risk behaviors. Talk to your child’s doctor about screening and make sure he or she is asking the tough questions. Be aware that, depending on your state’s law, the physician may not be required to divulge conversations they’ve had with your teen especially as they relate to sexual activity, pregnancy, and STDs.